12 Tips to Improve your Practice’s Billing and Collection Performance

Practices that have high hopes of improving the performance of billing and collection in an insurance claims work sphere should find this guide of basic instructions useful. The resource of ideation aims to eliminate common errors of practices; as observed in a study focused on insurance billing and collection.

Verify eligibility

1. Verification of insurance coverage and eligibility.

All registered patients should have a completed profile in the practice’ PMS (Patient Management System). The paramount goal of enforcing this protocol is to gather correct personal data from patients. This includes covered insurance and copayments. The support staff should record the latest insurance data and verify that it’s an active premium using an automated processing solution.

2. Pre-authorized payment processing and approvals.

Some health insurance policies such as HMO (Health Maintenance Organization) premiums require preauthorization before an insurer approves the claim. Coverage for procedures such as oculoplastics, retinal surgery, and pediatrics fall under this umbrella. A practice should exercise prudence in getting a coverage approved within the 48-hour window before treating a patient. It’s a practical measure to minimize the risk of lost revenue.

Patient data

3. Verification of patient insurance data on arrival.

Modern card scanning software used in practice management feature advanced settings for insurance image processing and data storage. It’s a security protocol to improve accuracy and proper verification of patient information. It increases processing time for new and returning patients. This payment processing solutions complement front desk operations and increase employee efficiency.

4. In- office copayment processing and collection.

It’s of utmost importance that the practice staff process collectible deductibles, copayments, and noncovered services at the point of treatment. It’s risky to send an invoice for collection after treatment. Numerous practices have failed to collect payments in similar situations.

Insurance Claims Auditing

5. Weekly auditing of processed charges report.

It’s a duty to keep things organized in a medical practice facility. With an efficient PMS in place, billing and collection is a breeze. It’s an efficient record keeping method to make a comparison of receivables and patient appointment records.

6. Charge entry checking.

Billers and coders in practice should review all provider-entered transactions before submission. Today’s methods of IEMR (Integrated-Electronic-Medical-Record) management tools include advanced features that allow a practice keep every bit of patient data safe and organized. It makes checking for unauthorized modifiers and errors easier. Medical professionals that incorporate this upgrade into practice encounter fewer denials and revenue losses.

calculate fees

7. Fee allowance and assessment.

Some practices run into problems because of incorrect fee calculation. It’s imperative that he or she sets a reasonable fee to get a full compensation for medical service. A sound approach to guarantee 100% satisfaction in using this fee scheduling method is to set a higher fee.

8. Record entries and process charges instantly.

In medical practice, record keeping is a duty, but it’s of utmost importance that the staff records each transaction promptly. This is to limit the risk of errors and nonpayment. A practice should put an efficient PMS in place to avoid encountering such problems.

insurance claims

9. Automated insurance claims editing.

It’s easier to edit insurance claims in a PMS to minimize errors and increase productivity. This decreases the risk of insurance claims rejection. If the existing PMS being used doesn’t support auto-editing, a practice should explore a third-party solution. It’s a useful billing and collection solution to increase accuracy.

10. Claims submission scheduling.

In a billing and collection setting, it’s imperative that the staff submit all claims to the clearinghouse by the end-of-business. Some practices schedule this activity on tri-weekly basis. It’s imperative to keep a consistent schedule when managing claims submission. If a practice office fails to keep a time-efficient scheduling system in place; he or she is likely to have payments delayed, claims adjudicated or rejected.

Claim Rejection

11. Clearinghouse rejection review.

A crucial aspect of billing and collection is ensuring that all claims have undergone stringent background checks. Sometimes, a biller or coder forgets to review rejected claims. It’s an essential billing and collection management rule that a coder/biller checks all rejected claims within 24 hours after submission.

12. Payment posting review.

This part of billing and collection from an insurance standpoint involves a sequence of processes for successful payment posting. Electronic remittance and work rejection control play a key role in effecting a smooth payment posting experience. As the staff encounters rejections, it’s imperative that they address the problem immediately. They should also check the database to identify all unpaid and rejected claims to gauge the correctness of entries.

Written guide

This helpful guide puts emphasis on effecting positive change in a billing and collection work sphere. Practices that fail to implement efficient management of insurance claims and payments are likely to lose revenue. The steps aren’t complication and should encourage workforce efficiency. The presence of a PMS guarantees a smooth process as well.

We’re glad you read our post. If you have any feedback, please share it below. If you need cms 1500 02/12 to file insurance claims, head over to Justcms1500forms.com. Personally, I prefer to purchase Cms 1500 version 02/12 forms for my practice from a manufacture (like they are), instead of a re-seller who doesn’t guarantee their product. For those of you that file more than average numbers of claims, they offer software for that as well. Look out for my next article soon.

In recent news stories, top retailer like Home Depot and Target have been heavily impacted by data breaches, and the bad news is that these are only a few of the many retailers who have been targeted by hackers of the years. This problem continues to be prevalent, and most consumers are well aware of these data breaches. Nonetheless, there is a growing trend for consumers to become even more connected. This implies that consumers are simply refusing to change their habits despite the concern about data breaches and the impact that a data breach may have on them.

Tax Data Breach

The Increased Connectivity of Today’s Consumers

It is widely known that today’s consumers are more connected than ever. In a world where more than 1.75 billion people own a smartphone, consumers of all ages regularly tote access to their bank accounts, email and more with them via their phone. They have apps on their smartphones as well as other mobile devices that may enable them to raise and lower the garage door or to adjust the thermostat at home. They can transfer money from account to account or pay their bills while sitting on a park bench, and they can buy movie tickets for the next showing of a blockbuster while sitting at a restaurant on a date.

Tax Software Connectivity

A Growing Trend

This trend in connectivity is only expected to increase. The new wearable devices, such as connected wristwatches and glasses will add to the connectivity of today’s consumers. More than that, businesses are jumping on the bandwagon known as the Internet of Things. More and more companies are trying to find ways to connect their own products and services to the Internet through the development of apps and other programs. The bottom line is that today’s consumers are indeed connected and likely will become even more connected in the near future.

The Awareness of Data Breaches

With this growing trend toward connectivity, it almost seems as though consumers are not aware of the risks associated with data breaches, identity theft and other related concerns. However, in a 2014 survey conducted by ISA CA IT Risk/Reward, approximately 94 percent of American consumers surveyed were aware of the recent data breaches with major retailers like Home Depot and Target. More than that, approximately 75 percent of those surveyed say that they have become more concerned about their personal data privacy with retailers within the last year.

awareness

The Refusal of Consumers to Change Their Habits

Given these statistics, it may be reasonable to think that consumers would make some changes to their buying habits or to their use of technology in an effort to increase their level of security and privacy, but this is not necessarily the case. The fact is that only 45 percent of those responded have taken even the basic effort to change a security feature like a password or PIN in an effort to protect themselves. More than that, less than 38 percent have made any change to their buying habits. This means that the majority of those who have been surveyed about breaches within the last year have made any noticeable changes to curb or alter their spending behavior.

A clear case in point is the 2014 increase in accounting and tax pros who feel safe when they efile 1099 forms on behalf of their clients. However, those professionals using the platform to submit tax forms are still relatively small in number compared to the overall markets.

Habits

Despite the IRS’s insistence that the data is safe and their servers possess the latest technology to keep that info secure, the market is still hesitant to adopt e-filing completely. Speak to any tax professional – already using the e-file system – who is about to file 1099 misc online for their client, and they’ll probably say that they believe in the IRS’s safeguards.

However, for every one of these early adopters, there are 20 or more tax pros who still believe in paper filings, for whatever reason. Only time will tell if data breach events continue to cause concern in the second group, and don’t affect the first set of individuals.

What IT Professionals Have to Say

Consumers who fail to make changes to protect their own security and privacy are essentially leaving their security and privacy in the hands of the retailers that they do business with. The unfortunate truth, however, is that the majority of the IT professionals who have recently been surveyed have stated that their companies are not yet prepared to accommodate the Internet of Things and the growing trend to use wearable devices. More than one-third of Americans have a smart TV and more than 27 percent are connected in their cars. There is an expectation that the Internet of Things will increase more significantly as the trend toward wearable increases, and it is simply not feasible to expect IT departments to be ready to accommodate this growing trend when many have stated that they simply are not ready.

Tax professionals

The Concern About What This Means For the Future

The fact is that many consumers believe that they will adopt wearable connective devices in the near future, including in the workplace, and IT professionals are not prepared for this wave. In fact, the recent data breaches indicate that companies today are not able to fully able to protect consumers from data breaches with the current level of technology. This means that consumers simply must take action on their own by changing passwords and PINs for their own security from time to time and by taking other similar actions. They should also monitor safety and security concerns with some retails and make decisions to only make online purchases from retailers that go the extra mile to keep their data and private information safe.

In the highly technological environment that we live in today, consumers and businesses alike must be aware of the risks associated with hacking, data breaches and more. More than that, consumers and businesses must both take steps to minimize these risks. Their efforts must continually advance as the technology that is being used advances and as the efforts of hackers and cyber criminals’ advances. There likely is no surefire way to completely eliminate this risk in the technological environment that we live in, but there are efforts that can be made regularly to minimize the risks.

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